VACCINATING PEOPLE CAUGHT IN CONFLICTS — Getting Covid-19 vaccines to people in poor countries has been hard, but getting them to people in conflict zones or refugee camps has been even harder. Some 82 million people were forcibly displaced at the end of 2020, and with multiple crises around the world, more people will probably be affected by year’s end.

Many live in crowded and unsanitary conditions and have limited access to health care — making it easier to get sick from Covid or other infectious diseases. Some countries hosting refugees have included them in their Covid vaccination drives. But bureaucracy has hampered efforts to get people vaccinated in parts of the world where no government is in charge.

Aid organizations working in those areas could apply to get vaccines from the global vaccine equity effort COVAX, but they couldn’t bear the threat of legal liability and compensate people who have serious adverse reactions from the vaccine. Pharma companies have made that a condition to supply governments with shots.

Clover, Sinopharm and Sinovac agreed to waive indemnification requirements. Johnson & Johnson joined them in a U.S.-brokered deal, Secretary of State Antony Blinken announced Wednesday at a virtual meeting with fellow foreign ministers. J&J told Global Pulse it was proud to offer its one-shot vaccine to the world’s most vulnerable people but didn’t address questions on the deal’s details.

U.S. Rep Raja Krishnamoorthi (D-Ill.) called on Moderna to do the same. A spokesperson for Gavi, the organization that runs the COVAX daily operations, urged other governments to advocate with vaccine manufacturers that have promised shots to COVAX “in support of this critical moral and public health imperative.”

Demands for delivery: Blinken also announced a new global Covid dashboard and a partnership with private companies to support vaccination campaigns at Wednesday’s meeting, which had close to 40 participants, including China’s Ambassador to the U.S. Qin Gang.

World Health Organization boss Tedros Adhanom Ghebreyesus, who also participated, asked foreign ministers to immediately set up a working group to deliver 550 million vaccine doses needed to ensure 40 percent of each country’s population is vaccinated by year’s end.

That’s doable if countries let COVAX jump the queue for deliveries, said Carolyn Reynolds, co-founder of the Pandemic Action Network, which asked Blinken ahead of the meeting to come up with a plan toward vaccinating 70 percent of each country’s population by September 2022. While welcoming the meeting’s efforts, Reynolds said her group was disappointed there were no details of such a plan.

WELCOME BACK TO GLOBAL PULSE, where we cannot think of a better statement on the impact of climate change than Tuvalu’s foreign minister delivering his speech to the COP26 from the sea that continues to rise in his South Pacific island nation.

Global Pulse is a team effort. Thanks to editors Eli Reyes and Barbara Van Tine. Follow us on Twitter: @carmenpaun and @_daniel_payne. Send tips and ideas to [email protected] and [email protected].

HOW TO AVOID INEQUITY IN COVID PILL ACCESS — A year after the first promising news about Covid vaccines, the world is again hopeful of new tools against the virus: pills that could be taken at home by people infected with the coronavirus.

But will the world avoid last year’s scenario, when rich countries snapped up most of the global vaccine supply, leaving poorer countries without enough shots?

There are signs that this time might be different.

Merck and Ridgeback Biotherapeutics won the first approval of their molnupiravir drug in the U.K. last week and granted a royalty-free license to the Medicines Patent Pool, which should help generic manufacturers produce the drug for more than 100 poor countries. The companies also have voluntary license deals with generic manufacturers in India.

A Bangladeshi company is gearing up to sell a generic version of the drug, which received emergency authorization in the country. The cost to patients? $33 per treatment course.

The plans to ensure equitable access are murkier for Pfizer’s antiviral pill Paxlovid, which the company said reduces hospitalization and death by as much as 89 percent when taken within three days from when symptoms appear.

Low- and lower-middle-income countries will pay a not-for-profit rate for the pill, Pfizer spokesperson Kit Longley told Global Pulse. The company is also exploring manufacturing options to help get the pill to poorer countries.

“It’s a bit premature to share the specifics of any future agreements as discussions are ongoing,” he said. Pfizer has advance purchase agreements with multiple countries, and negotiations with several others are ongoing.

The Merck deal with the Medicines Patent Pool and Indian generics manufacturers is the gold standard for expanding access, said Trevor Mundel, the global health president at the Bill & Melinda Gates Foundation. Generic manufacturers that can produce much cheaper drugs at high volumes will help get more of it to countries.

But generic manufacturers need to move early to secure approval for their copycat drugs, and the manufacturing process must be made cheaper, Mundel said. For example, the Gates Foundation invested in reducing molnupiravir’s production costs by simplifying the process and replacing the starting material with a cheaper one, he said.

This “gets us down into probably single-digit cost of the drug from $700 here in the U.S., which would be totally unaffordable,” Mundel told Global Pulse.

If all these actions don’t occur, “you're going to get six months delay or a year delay before you have any supply in Africa, for instance,” he said.

THE MODERNA-U.S. DEAL — The company that hadn’t yet brought any product to market got full ownership of the technology behind a Covid vaccine despite its reliance on years of National Institutes of Health research. That was part of an August 2020 deal between Moderna and the Trump administration securing 500 million vaccine doses for the U.S., POLITICO’s Adam Cancryn, Sarah Owermohle and Erin Banco report.

In July, Moderna requested a patent for the central component of its Covid vaccine, leaving out three government scientists who worked on it, The New York Times reports.

Despite acknowledging the NIH’s role in developing the vaccine, only Moderna’s scientists designed it, a company spokesperson said. The NIH plans to take the case to court.

The biggest losers are people in poor countries who could have benefitted from the U.S.’s sharing of the vaccine technology or cheaper vaccine prices.

THE COP26 HEALTH CARE REPORT CARD — This year’s meeting about climate change has involved some conversation about health care — both inside or outside the official conference — including an agreement to incorporate health care systems in decarbonization efforts and a session on the link between climate change and future pandemics.

But was it enough? As COP26 comes to a close Friday, Global Pulse asked experts to grade this year’s conference, especially its impacts on climate-related health risks.

David Miliband, president and CEO of the International Rescue Committee

Grade: C

Miliband said that though he saw some signs of progress through the conference, they don't match the pace at which health and peace are threatened by climate change.

“There are subsidiary issues, like climate and conflict or climate and displacement or climate and health, which have struggled to get a look-in,” he said. “I think that along the current trajectory, I would say, the glass is a quarter full, you know. It's not an F because there was agreement on methane, there was agreement on forestry — and they need to be followed through — there are more NDCs. But it’s a C, not an A."

He said the evidence for discussing the issues, though, is clear.

“We're a humanitarian agency, and what we see is that the indirect effects of the climate crisis are potent already, never mind the direct effects.”

Max Jungmann, political scientist focusing on the intersection of climate change and health

Grade: B

Jungmann said the issue of health outcomes from climate change “is definitely much higher up on the agenda than it used to be.”

Issues of climate-linked health risks are not only gaining steam in the conference but also — maybe to a greater degree — in events and protests outside of the official events, he said.

“The World Health Organization for the first time ever has its own booth at the COP,” he said. “It's very, very present in influencing the agenda. But when we’re talking about actual outcomes — outcomes as part of we’re expecting as a resolution or an agreement ... I barely found any significant proposal yet, for example, on strengthening funding for health research.”

Aaron Bernstein, who directs research on health and the environment at Harvard.

Grade: A

“In the context of past COPs, I think we’ve seen an unprecedented amount of attention to the health effects of climate change,” he said.

Bernstein, who spoke about the relationship of environment and health at the conference, said he was not concerned that health wasn't a focus of the agreements, because the gathering set out to focus on greenhouse gas emissions.

“My goal is that the agreements are more robust because people recognize that, when they do these things, they have the opportunity to provide health,” he said. “The idea that climate action is essential to protect health now is creeping into the understanding of why this is so important — and that, to me, is just such an important part of getting us where we need to go.”

Daniel Kass, senior vice president of Environmental Health at Vital Strategies

Grade: D

“One issue that has been largely left out of COP26 conversations: health,” Kass wrote in an email to Global Pulse. “An important first step in treating climate change as a public health crisis is changing the way we look at the true cost of carbon. If we factor in the negative impact of carbon emissions on health and welfare, some estimates would more than triple the cost. Has there been sufficient discussion about the true social cost of carbon? Largely no. And while the presence of public health was greater at this COP than previous, there’s an over-emphasis on the healthcare sector’s contribution to emissions at the expense of it.

“Overall Grade: D. But as any good educator knows, a D grade increases the likelihood someone will drop the course, or worse, school. I want to believe a B or A is within reach with a lot more work.”

WHAT'S STOPPING ACTION ON CLIMATE-LINKED HEALTH RISKS? — While it may seem the evidence proving the harms of climate change is abundant, a new WHO survey suggests that, for dozens of countries, more research is needed to create and implement strategies to minimize health risks from climate change.

Broad health impacts, like those from higher temperatures near the equator, have long been researched. But specific, localized evidence — often needed to create effective programs and convince leaders of their benefits — can be lacking. Nations already hit with resource barriers often have accompanying research barriers, climate and health experts told Global Pulse.

Covid-19 has put even more strain on efforts to implement plans to minimize climate-linked health risks. Countries that started out with few resources for these programs were among those hit hardest by the pandemic, according to the experts.

Radio Free Asia: A North Korean hospital sent 10 people with Covid-19 symptoms to an unheated ward in freezing temperatures, and then falsified the causes of their deaths to maintain Pyongyang’s claim that the country is virus-free.

Al Jazeera: Will Taliban support for a vaccination drive eradicate polio?

Devex: World Bank boss criticizes donor countries for messy Covid-19 vaccine delivery.

Reuters: The U.K. will recognize vaccines endorsed by the WHO to allow international travelers into the country as of Nov. 22.